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Biomedical subjects

D S Richards

Publications and source records attributed to D S Richards.

At least 19 recordsLinked to original sources
PubMed2000

Patient acceptance of endovaginal ultrasound.

OBJECTIVE: To assess women's experiences and attitudes regarding endovaginal ultrasound. METHODS: Women attending the obstetrics and gynecology clinics at the University of Florida were asked to complete an anonymous questionnaire. RESULTS: Of respondents who had had a prior endovaginal ultrasound examination, 26% reported that 'it hurt a lot' and 50% reported that 'it hurt a little'. In contrast, only 23% of patients had experienced any pain with a prior abdominal ultrasound (P < 0.001). Multivariate analysis showed that discomfort with a prior vaginal ultrasound was related to patient age category, with less discomfort being experienced with increasing ages (P = 0.001). A history of unwanted sex, sexual or physical abuse, or dyspareunia was not associated with more painful examinations. Most patients were willing to undergo a future vaginal ultrasound investigation if it were recommended by their doctor. Multivariate analysis showed that more willingness was associated with older age category (P = 0.004), a history of dyspareunia (P = 0.03) and bleeding in a current pregnancy (P = 0.005). Of the patients (less than half) who had a preference, most preferred a female sonographer for endovaginal sonography (P < 0.001) and most preferred that a doctor, rather than a nurse or technician, perform the examination (P < 0.001). CONCLUSIONS: The majority of women who had experienced a vaginal ultrasound examination found it somewhat uncomfortable, but almost all women who returned the questionnaire expressed a willingness to undergo endovaginal ultrasound if it were recommended.

Adolescent↗
PubMed2000

Preinduction cervical assessment.

Systems of quantifying and scoring cervical factors have been sought for years to predict the duration of labor and to determine which patients may successfully and safely undergo induction of labor. Early methods of cervical assessment generally attempted to classify patients as having favorable or unfavorable cervices based on dichotomous variables. Since then, obstetricians have begun to appreciate the usefulness of having a single score derived from the degree of ripeness of several cervical characteristics. The scoring system that has become most prevalent is the Bishop score. This system and its modifications take into account the dilation, effacement, consistency, and position of the cervix in addition to the station of the presenting part. Many have evaluated and confirmed the validity of the Bishop score. Among the factors considered in assigning the score, the strongest association with successful labor seems to be with cervical dilation. The Bishop score has been criticized for not attributing more significance to cervical dilation. However, despite this criticism, none of the modifications to the original scoring system have been shown to improve predictability. More recently, the use of ultrasound assessment of the cervix has been suggested to improve prediction of the success of labor induction. However, convincing evidence that this technique provides significant additional information when compared to digital examination is lacking. The Bishop score would seem to be the best and most cost-effective method currently available to assess the cervix and predict the likelihood of success of labor induction and the duration of such an induction.

Cervical Ripening↗
PubMed1999

Nonimmune hydrops fetalis: fetal and neonatal outcome during 1983-1992.

Prognostic factors for survival of 62 fetuses and neonates with nonimmune hydrops fetalis (NIHF) were studied retrospectively. Twenty-eight infants survived >/=28 days which is 45% for all fetuses and newborns diagnosed with NIHF and 61% for liveborns with unresolved NIHF. Univariate analysis identified that mortality was associated with the presence of >/=2 serous cavity effusions and a need for chest compressions at birth. Multivariate logistic regression analysis confirmed that the presence of >/=2 serous cavity effusions was significantly associated with mortality from NIHF <28 days after birth [OR = 48.2 (CI 3.6, 662.9) (p < 0.004)]. We conclude that, compared to published cases from the 1970s and early 1980s, survival of liveborns with NIHF seems improved. The decrease in stillbirths is more notable. The severity of hydrops at birth is the key determinant for survival.

Female↗
PubMed1998

Second-trimester vaginal bleeding: correlation of ultrasonographic findings with perinatal outcome.

OBJECTIVE: Our purpose was to determine the relationship between ultrasonographic findings and perinatal outcome in patients with second-trimester vaginal bleeding. STUDY DESIGN: A retrospective case-control study was performed. One hundred sixty-seven patients with ultrasonographic examinations performed for bleeding between 13 and 26 weeks' gestation were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of an intrauterine clot, membrane separation, and placenta previa. A control group of 167 patients was obtained by selecting the next consecutive patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded. RESULTS: Multiparity was more common in patients with bleeding than in controls (69% vs 58%, p = 0.036), as was history of two or more previous preterm deliveries (6% vs none, p = 0.005). Second-trimester vaginal bleeding was associated with increased risk of preterm delivery (relative risk 1.9, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidence interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% confidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into two groups. Among the patients with second-trimester vaginal bleeding those with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations. CONCLUSION: Second-trimester vaginal bleeding is more common in multiparous women and in women with a history of a previous preterm delivery. Perinatal morbidity and mortality is increased in patients with bleeding during the second trimester. The risk is compounded when abnormalities are detected by ultrasonography.

Adult↗
PubMed1998

Prenatal ultrasound diagnosis of massive subchorionic thrombohematoma.

Massive subchorionic thrombohematoma is a rare condition in which a large maternal blood clot separates the chorionic plate from the villous chorion. This condition is usually complicated by intrauterine growth restriction, and is often associated with fetal distress and perinatal death. We present a case in which the diagnosis of massive subchorionic thrombohematoma was made at 24 weeks' gestation. Doppler ultrasound helped to confirm the diagnosis and demonstrated severely abnormal umbilical blood flow. Two days after the diagnosis, fetal distress prompted emergency Cesarean delivery of a growth-restricted infant.

Adult↗
PubMed1997

High-performance liquid chromatography/NMR spectrometry/mass spectrometry: further advances in hyphenated technology.

The earlier use of combined liquid chromatography/NMR spectrometry/mass spectrometry (LC/NMR/MS) involved the use of a particle beam interface. This paper describes further developments of this hyphenated technology, in particular the incorporation of an electrospray interface into the LC/NMR/MS system. This improved LC/NMR/MS system was designed for the support of a combinatorial library program. The power of this technique is demonstrated in the successful structural elucidation of each compound in a mixture of commercially available peptides.

Chemical Phenomena↗
PubMed1997

The etiology of fetal acidosis as determined by umbilical cord acid-base studies.

OBJECTIVE: Our purpose was to determine whether umbilical cord acid-base values might be used to differentiate abruptio placentae from cord prolapse. STUDY DESIGN: By use of a retrospective study design, umbilical cord blood acid-base values of 32 cases of severely acidotic acute abruptio placentae were statistically compared with those of 19 cases of severely acidotic acute cord prolapse with Fisher's exact test, Mann-Whitney U tests, and receiver-operator curve characteristic analyses. RESULTS: No significant differences in electronic fetal heart rate record interpretations were detected. Highly significant differences in umbilical arterial and umbilical venous blood gas values were noted between the two groups. Most notable were the differences between umbilical venous and arterial blood gas values in the cord prolapse group. Receiver-operator characteristic curve analysis demonstrated that an umbilical venous-arterial pH difference of 0.15 was an effective cutoff value in differentiating cord prolapse from abruptio placentae (accuracy 92%). CONCLUSION: Umbilical arterial blood gas values combined with umbilical venous blood gas values can assist in determining the pathogenesis of marked fetal acidosis.

Abruptio Placentae↗
PubMed1997

On-line liquid chromatography coupled with high field NMR and mass spectrometry (LC-NMR-MS): a new technique for drug metabolite structure elucidation.

High performance liquid chromatography has been coupled simultaneously to high field NMR and MS detectors, giving UV, NMR and mass spectra for each component in a mixture, after on-line separation. This powerful new tool for the structure elucidation of components in mixtures without isolation has been successfully applied to the analysis of the metabolites of paracetamol in human urine.

Acetaminophen↗
PubMed1996

The prenatal sonographic appearance of enteric duplication cysts.

Enteric duplication cysts are rare lesions, and relatively few cases have been diagnosed prenatally. We report two cases with a distinctive presentation. One, a duplication of the antrum of the stomach, was adjacent to an extralobar pulmonary sequestration. The other, a duodenal duplication, appeared as a thick-walled right lower quadrant cyst. We observed distinct peristalsis in this cyst, a finding that helped us make a firm diagnosis of enteric duplication.

Adult↗
PubMed1996

Congenital diaphragmatic hernia. Epidemiology and outcome.

Congenital diaphragmatic hernia is a relatively common birth defect. It affects about 1114 babies a year in the United States. Reported survival averages 60% but may be significantly lower. We do not understand the etiology of CDH. Its association with other anomalies and several distinct patterns of presentation suggest that more than one cause may exist. There is a high degree of variability in both treatment and outcomes, but no data exist to allow a rigorous comparison of the efficacy of various treatment strategies. Stratification of patients into more homogeneous groups will be a necessary prerequisite for the design of meaningful comparative trials. The incidence of the lesion prevents any single institution from accruing sufficient patients to conduct such a trial. An ad hoc multicenter study group (the Congenital Diaphragmatic Hernia Study Group) has been formed for this purpose. This organization has begun collecting data with an initial goal of developing a stratification scheme. Prospective data collection should allow verification of several of the estimates made in this article. Current data make it clear that CDH represents a major cause of perinatal morbidity and mortality.

Hernia, Diaphragmatic↗
PubMed1995

Pregnancy outcome for women with very low levels of maternal serum unconjugated estriol on second-trimester screening.

OBJECTIVE: Our purpose was to assess pregnancy outcome for women whose second-trimester triple screen results revealed very low unconjugated estriol levels. STUDY DESIGN: Of 44,146 women screened for alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol, a group of women with isolated very low unconjugated estriol levels were selected as the study group. Pregnancy outcome was obtained by contacting the referring physicians. RESULTS: During the study period 62 women had unconjugated estriol levels at or below the sensitivity of the assay. Fetal death was the most common explanation, accounting for 37.1% of cases. Six cases of early death followed uneventful prenatal visits. Eighteen women had unexplained very low unconjugated estriol levels. Of these 18, four cases of placental sulfatase deficiency were diagnosed. Sixteen of these 18 women gave birth to male infants (p = 0.03). CONCLUSION: A very low unconjugated estriol level in the second trimester is associated with increased risk for early death and placental sulfatase deficiency.

Adult↗
PubMed1995

Prenatal diagnosis of fetal disseminated intravascular coagulation associated with umbilical cord arteriovenous malformation.

BACKGROUND: Congenital disseminated intravascular coagulation (DIC) has been reported in a variety of clinical settings, but to our knowledge, it has never been documented before birth. We describe prenatal identification of an umbilical cord vascular tumor and echogenic foci in the fetal liver leading to the diagnosis of fetal DIC by funipuncture. CASE: A large vascular tumor of the umbilical cord was identified using prenatal sonography. At 31 weeks' gestation, echogenic areas, which were thought to represent infarcts or thrombi, were seen in the liver. When funipuncture revealed florid fetal DIC, delivery was accomplished by cesarean to prevent intracranial bleeding. Pathologic examination of the umbilical cord tumor showed it to be a large arteriovenous malformation. CONCLUSION: Arteriovenous malformations may cause fetal coagulopathy. This case illustrates that funipuncture may be used to diagnose this condition and that timely cesarean delivery may contribute to a favorable outcome.

Adult↗